Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 011488 | LA |
NPI | 1003991423 |
---|---|
Provider Name | Dr. Van Michael Ardoin |
First Address | Houma, LA 70360 |
Second Address | Houma, LA 70360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 18/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1146170 | (05) | LA |
B62667 | (02) |